Flu vaccine is not as effective as public health messaging
traditionally has claimed, says a new report that suggests
overselling of flu shots is getting in the way of developing more
effective and longer lasting vaccines.

Existing flu shots offer moderate protection some years and less
in others and in general are "sub-optimal," according to the
report, from public health experts at the Center for Infectious
Diseases Research and Policy at the University of Minnesota.

"Our current influenza vaccines work for some of the people some
of the time. And we clearly need vaccines that work for most of the
people most of the time," Dr. Michael Osterholm, director of the
center, said in an interview Monday.

While the report strongly urges the development of
"game-changing" vaccines, it says in the meantime people should use
the tool that exists.

"We recommend you continue to get your flu shot. It’s the
best protection we have. But it’s not enough," Osterholm
said.

He is first author of the report, which is the product of a
three-year investigation into the science supporting flu vaccine
efficacy and safety and the decision-making processes that led to
the U.S. policy to recommend all Americans get a flu shot every
year.

The project that led to the report was called the CIDRAP
Comprehensive Influenza Vaccine Initiative, and it involved mining
more than 12,000 documents, articles and meeting transcripts as
well as more than 5,700 peer-reviewed vaccine studies published
from 1936 through April 2012.

The work was funded in part by a grant from the Alfred P. Sloan
Foundation.

Interestingly, where five years ago claims like these likely
would have been denounced as public health heresy, this report, in
the main, is receiving a much warmer welcome.

In recent years studies by a variety of research groups --
including in Canada -- have shown that the long-quoted claims that
flu shots offered 70 to 90 per cent protection against influenza
have been off the mark.

Somewhere in the order of 50 to 60 per cent, in healthy adults,
is more accurate, the newer studies suggest. Efficacy rates are
lower in the elderly or people in poor health.

The report suggests that the higher numbers came from old
studies done on vaccines that were not formulated the way current
shots are. It also suggests that the belief that universal
vaccination for flu would be useful and desirable, rather than
solid scientific evidence, was what drove decisions to recommend
flu shots for all in the U.S. (The study did not look at decisions
made in Canada or elsewhere.)

Even the vaccine used in the U.S. during the 2009 pandemic --
where there was a perfect match between the virus in the vaccine
and the strain infecting people -- didn’t offer better
protection. Studies cited in the report pegged the U.S.
vaccine’s effectiveness at 56 per cent.

Dr. Danuta Skowronski, an influenza expert at the B.C. Centre
for Disease Control, is involved in flu vaccine efficacy studies
that have been conducted annually in Canada since 2004. She said
the findings of those studies support the arguments made in the
CIDRAP report.

The world spends enormous sums trying to vaccinate people
against influenza every year. In Canada alone, Skowronski said,
spending on flu vaccine programs likely exceed $100 million per
year.

"We need a better vaccine," she said. "And investing in improved
vaccine options may be more rewarding than expanding the use of the
current vaccine to greater segments of the population."

A key argument of the report is the fact that the current
vaccine that offers moderate protection is actually getting in the
way of developing long-lasting flu vaccines that offer more
effective protection -- vaccines, for example, that might require a
shot every five or 10 years. Currently flu shots are reformulated
every year to try to keep up with the evolution of flu viruses.

"I don’t want to oversimplify this dilemma of what do you
do now?" said Dr. John Treanor, an expert in flu vaccines and chief
of the infectious diseases division at the University of Rochester
(N.Y.) Medical Center.

"How do you at the one time promote the vaccine that you have
and at the same time create space to make new vaccines? I think
that’s a very difficult thing to do."

In recent years pharmaceutical companies -- spurred in large
part by massive funding from the U.S. government -- have been
working on ways to improve existing vaccines. But tweaking the
current vaccines won’t solve the problem, the report says,
insisting that what is needed are vaccines that target different
parts of the flu virus than the current ones do.

The enormous cost of developing such vaccines means the only way
they will come into existence is if governments support the work,
the report says, noting that producing a single new flu vaccine
could take 15 years of work and cost a company upwards of US$1
billion.

It called on the U.S. government to play the lead role in
pushing this agenda, saying the World Health Organization is not in
a position to do so.

And there is little incentive for industry to take the risk to
develop wholly new flu vaccine approaches, the report says.

Even though a flu shot is a relatively inexpensive vaccine,
manufacturers sell hundreds of millions of doses of them a year. In
fact, the report notes that the global market for flu vaccine is
estimated at US$2.8 billion -- a decent chunk of the estimated
US$20 billion annual market for all vaccines combined.

Treanor said in his estimation, a major advance in flu vaccines
is not around the corner.

"I think we’re very far away from the game-changing
vaccine right now."